Workers Compensation Insurance Quote NH

Gorman Insurance and Risk
Management Services of
Somersworth, NH offers
affordable Commercial
Insurance coverage options and
experienced business insurance
services throughout New
Hampshire, southern Maine,
and Massachusetts.

Contact us about Commercial
Auto Insurance toll free at 1-
800-678-3431, as well as
Group Health and Group
Disability Insurance services
for your NH, ME, or MA
business.

In addition to New Hampshire
Workers Compensation
Insurance, we also offer
affordable Group Life
Insurance plan services.

We are your local southeastern New Hampshire, southern Maine
insurance agency, offering experienced workers compensation
insurance services to businesses located in the following cities and
counties: Somersworth, Durham, Portsmouth, Dover, Rochester,
Rollinsford, Barrington, Madbury, Lee, Strafford, Farmington, Milton,
Barnstead, Nottingham, Northwood, Raymond, Newmarket, Newfields,
Stratham, Rye, Hampton, Epping, Exeter, Salem, Danville, Deerfield,
West Rye, Derry, Chichester, South Barnstead, Gilmanton, New
Durham, Wolfeboro, Alton, Laconia, Berlin, Lebanon, East Candia,
North Hampton, Hanover, Littleton, Plymouth, Claremont, Newport,
Keene, Hampton, Rye Beach, Strafford County, Rockingham County,
Hillsborough County, Merrimack County, and Belknap County, NH. We
also offer workers compensation insurance services throughout the
state of New Hampshire, including the Manchester, Nashua, and
Concord area. Our service area in southern Maine includes the following
cities and counties: South Lebanon, Kittery, Eliot, Berwick, Sanford,
Blaisdell Corners, Springvale, Emery Mills, Wells Beach, York Beach,
Kittery Point, Kennebunk, Saco, Biddeford, Alfred, Portland,
Scarborough, Westbrook, Waterboro, Shapleigh, Newfield, Buxton,
Goodwins Mills, South Sanford, Cape Elizabeth, South Portland, York
County, and Cumberland County, ME.

We provide affordable Workers Compensation

Insurance services throughout New Hampshire!

New Hampshire Workers
Compensation Insurance Quote

Business Name:
Premises Address:
City:
State: (New Hampshire, Maine or Massachusetts)
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)

About Your New Hampshire Business:

Federal Employer's ID #:
Description of Operations or SIC code:

# of full-time employees:     # of part-time employees:
# of locations:     Estimated Annual Payroll: $
Experience Mod (if any, per policy)

Select all that apply to your New Hampshire business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other

Recent Insurance Information:

Current Insurance Company:
Policy #: Expiration Date: (mm/dd/yyyy)
Losses past 3 years:
Description of losses or loss runs:

What types of coverages do you currently have:
Commercial Auto
Commercial Liability
Commercial Property
Workers Comp
Group Health
Group Life
Group Disability
Group Long Term Care
Other

Employee Information:

Employee       Classification Code       Yearly Payroll Estimate
      1                                         $
      2                                         $
      3                                         $
      4                                         $
      5                                         $

Officers / Partners / Owners Information:

Principal             Name                                          Title                    Include
      1
      2
      3

Additional Information or Comments

Click on the "Submit Quote Information" button below to send your
New Hampshire Workers Compensation Insurance quote request.**

**Information received from this New Hampshire Workers Compensation Insurance quote request form sent to Gorman Insurance and Risk Management Services, will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the workers compensation insurance policy information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle your business to a New Hampshire Workers Compensation Insurance Policy. We are licensed in New Hampshire, Maine, Massachusetts, and will not provide quotes for other states.

New Hampshire Business Information: